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PubMed2002

Statistical power analysis to estimate how many months of data are required to identify operating room staffing solutions to reduce labor costs and increase productivity.

UNLABELLED: We performed a statistical power analysis to determine how many historical data are needed for optimal operating room (OR) management decision making. The work applies to hospitals that provide service for all of its surgeons' elective cases on whatever workday the surgeons and patients choose. The hospital and anesthesia group adjust OR staffing and patient scheduling to care for the patients while minimizing OR staffing costs and maximizing labor productivity. Two years of data were obtained from a seven-OR surgical suite. The data were repeatedly split into training and testing datasets. The optimal staffing solution was calculated for each training dataset to maximize the efficiency of OR time usage and was then applied to the corresponding testing dataset. Training datasets ranged in size from 30 to 270 consecutive workdays. With 30 workdays of data, the statistical method identified staffing solutions that had an average of 35% decreased costs and 27% increased productivity as compared to the existing staffing plan. There was no significant improvement in performance with more than 210 workdays (10 mo) of data. With 30 workdays of OR or anesthesia group data, the optimization method can significantly reduce staffing costs and increase productivity compared with existing staffing. When applied routinely for adjusting staffing (e.g., on a quarterly basis), 9 to 12 mo of data should be used. IMPLICATIONS: With 30 workdays of operating room or anesthesia group data, the optimization method can propose staffing solutions that significantly decrease costs and increase productivity compared with existing staffing solutions. We recommend that, when the statistical method is applied routinely for adjusting staffing (e.g., on a quarterly basis), 9 to 12 mo of data be used.

Efficiency↗
PubMed1975

[Harzard of chronic exposure to halothane for operating room personnel].

This study shows that the staff working in an operating room is repeatedly being exposed to appreciable doses of halothane vapours. A continuous measurement of the concentrations in the ambient air gave results ranging from 5 to 30 ppm. Summits from 50 to 70 ppm were noted. The inhaling of halothane was evidenced by the presence of brominated metabolites in the urine of the staff. A mean 14,59 mg/l was found with women anaesthesists. Therefore it is quite possible that the halothane spread in the air should be held responsible for the discomfort felt in particular by anaesthesists. To prevent this risk of chronic intoxication by those vapours, there ought to be a device permitting either to evacuate them outside or to collect them while regenerating the polluted air through an active carbon filter if one has not got at one's disposal an airing system offering over 20 renewals of fresh air per hour. The fitting up of a permanent control device equipped with warning light and bell is also justified.

Halothane↗
PubMed1998

Sharps disposal in the operating room: current clinical practices and costs.

UNLABELLED: In the evolving medical environment, fiscal constraints on medical practice are becoming the norm. The new days of austerity have revived interest in the economics of medical practice. Economic measures, however, should not impinge on the quality of patient care. Waste disposal, in particular, is an area without any direct patient benefit but which carries both short- and long-term ecological costs. Much of how we dispose of waste is dictated in the United States by the Joint Commission for the Accreditation of Hospital Organization, Occupational Safety and Health Administration, state regulations, and individual hospital protocols. In an attempt to elucidate the waste in waste management, we examined the use of standard operating room sharp boxes. Full sharp boxes from three different operating sites were randomly saved. Boxes were weighed and opened, and contents were separated into appropriate sharps: loose needles, scalpels, syringes with uncapped needles, and other. Weight and volume assessments were performed on the nonsharps. True sharp values were derived from nonsharps data. Less than 50% of the contents were appropriate for sharps disposal, with empty glass vials constituting the greatest percentage by weight of nonsharps material. We believe that encouraging the appropriate use of sharps boxes is a potential source for savings. IMPLICATIONS: Sharp boxes were randomly saved from university operating rooms and analyzed for content. The full boxes contained 14% appropriate sharps by weight and <50% appropriate sharps by volume. The largest fraction of nonsharps weight was found to be glass.

Medical Waste Disposal↗
PubMed1977

[Radiation exposure to personnel during fluoroscopy in operating rooms (author's transl)].

The radiation doses to various sites of the body received by physicians and nurses during fluoroscopic work in the operating room have been measured by using LF/teflon dosimeters. The results are presented separately for skeleton and bile operation as well as implantations of cardiac pacemakers. The doses to hands, head, dorsum and gonads decrease in the given sequence. As to the radiation protection, the use of lead-rubber aprons is considered to be adequate.

Female↗
PubMed2003

Influences on compliance with standard precautions among operating room nurses.

BACKGROUND: Occupational exposures of health care workers occur because of inconsistent compliance with standard precautions. The purpose of this study was to develop national estimates of compliance with standard precautions and occupational exposure reporting among operating room nurses (specifically, scrub nurses) in Australia and to assess variables that influence compliance. METHODS: A descriptive correlation design was used to investigate relationships between variables and compliance, using a theoretical framework, the Health Belief Model, to give meaning to the variables. Data collection was done through mail-out surveys to members of the Australian College of Operating Room Nurses. RESULTS: This article reports the results of compliance with the following 2 specific self-protective behaviors: double-gloving and wearing adequate eye protection. Mean compliance rates were 55.6% with always double-gloving during surgical procedures and 92% with always wearing adequate eye protection. In addition, the variable that had the most influence on compliance was the perception of barriers to compliance, specifically, that adhering to standard precautions interfered with duties. CONCLUSION: These results have implications for the development of multifaceted perioperative infection control programs, including strategies for prevention, education, and policy development, to improve practices aimed at reducing occupational exposures among this high-risk group.

Adult↗
PubMed1990

Managing operating room budget variances.

Credibility, power, and the ability to obtain greater departmental resources are three benefits of managing the operating room (OR) department's operating budget effectively. Still, few resources exist to help novice as well as seasoned OR directors grapple with the practicalities of maintaining their budget after the annual budget process is completed. The authors examine how astutely controlling personnel, materials, and services budget variances will result in hospital administrators "hearing" and approving an OR director's requests for resources more readily, staff and physicians who enjoy the benefits of better-staffed services and new technology, and an OR director with a reputation as an effective department head among peers in the hospital.

Administrative Personnel↗
PubMed2003

Use of operating room information system data to predict the impact of reducing turnover times on staffing costs.

UNLABELLED: Potential benefits to reducing turnover times are both quantitative (e.g., complete more cases and reduce staffing costs) and qualitative (e.g., improve professional satisfaction). Analyses have shown the quantitative arguments to be unsound except for reducing staffing costs. We describe a methodology by which each surgical suite can use its own numbers to calculate its individual potential reduction in staffing costs from reducing its turnover times. Calculations estimate optimal allocated operating room (OR) time (based on maximizing OR efficiency) before and after reducing the maximum and average turnover times. At four academic tertiary hospitals, reductions in average turnover times of 3 to 9 min would result in 0.8% to 1.8% reductions in staffing cost. Reductions in average turnover times of 10 to 19 min would result in 2.5% to 4.0% reductions in staffing costs. These reductions in staffing cost are achieved predominantly by reducing allocated OR time, not by reducing the hours that staff work late. Heads of anesthesiology groups often serve on OR committees that are fixated on turnover times. Rather than having to argue based on scientific studies, this methodology provides the ability to show the specific quantitative effects (small decreases in staffing costs and allocated OR time) of reducing turnover time using a surgical suite's own data. IMPLICATIONS: Many anesthesiologists work at hospitals where surgeons and/or operating room (OR) committees focus repeatedly on turnover time reduction. We developed a methodology by which the reductions in staffing cost as a result of turnover time reduction can be calculated for each facility using its own data. Staffing cost reductions are generally very small and would be achieved predominantly by reducing allocated OR time to the surgeons.

Algorithms↗
PubMed1990

[A study on the effect of waiting time for operations in the operating room on preoperative patients].

This study was attempted to provide us with basic information on how to improve understanding with patients for operation, and to offer them better nursing and treatment. This kind of study will help scientific application to nursing practice and operating room. The data was collected by interviewing 29 patients who underwent the elective surgery under the general anesthesia at Y hospital in Seoul. The interview ran from October 15 to December 15, 1989. The research instrument was a anxiety measurement device (SAAI) originally developed by Spielberger, et al and modified by Jung-Tack Kim. 1. Hypothesis Testing Hypothesis one was that there would be a difference in state anxiety level according to a time difference in waiting for operation. This hypothesis was rejected (state anxiety level one hour before operation P greater than .05, r = .747, State anxiety level half an hour before operation P greater than .05, r = .1550, state anxiety level just before operation, P greater than .05, r = .1099). However, state anxiety level appeared to be associated with a longer waiting period, like one day before operation (P less than .05, r = .4628). Hypothesis two was that there would be a difference according to state anxiety level of patients for operation. This was rejected. (Change of blood pressure in systolic P greater than .05, r = -.1082. Change of blood pressure in diastolic P greater than .05, r = -.088, Change of pulse rate, P less than .05, r = 1.909) 2. Examining trait anxiety and state anxiety levels, the average level of trait anxiety was 42.034, and the average level of state anxiety one day before operation was 43,000. The average level of state anxiety was averaged 42.356 in a waiting room for operation. 3. Examining the state anxiety level by time period, the level one hour before was 42.379, the level half an hour before 42.276, and the level just before operation 42.414. The low level of state anxiety was due to the fact that premedication was not eliminated. 4. Age and time period like one day before operation was related to state anxiety level (F = 5.271, P less than .001) and blood pressure in waiting room for operation. That is, state anxiety level and blood pressure of patients one day before operation appeared high. Sex was related to changes of blood pressure; the blood pressure of male patients appeared higher than that of female patients.(ABSTRACT TRUNCATED AT 400 WORDS)

Anxiety↗
PubMed1987

Oxygen saturation during transfer from operating room to recovery after anaesthesia.

Transcutaneous oxygen saturation of haemoglobin was measured in 101 patients en route from the operating room to the recovery room. Twenty-nine became significantly hypoxaemic during the journey. The incidence of hypoxaemia was not found to relate to age, weight, duration or type of surgery, type of anaesthesia or pre-existing disease. Duration of the interval between cessation of oxygen in the operating room and arrival in recovery room was the only significant finding in patients who became hypoxaemic.

Adolescent↗
PubMed2003

Improvement of intraoperative antibiotic prophylaxis in prolonged cardiac surgery by automated alerts in the operating room.

OBJECTIVE: To assess the impact of an automated intraoperative alert to redose prophylactic antibiotics in prolonged cardiac operations. DESIGN: Randomized, controlled, evaluator-blinded trial. SETTING: University-affiliated hospital. PATIENTS: Patients undergoing cardiac surgery that lasted more than 4 hours after the preoperative administration of cefazolin, unless they were receiving therapeutic antibiotics at the time of surgery. INTERVENTION: Randomization to an audible and visual reminder on the operating room computer console at 225 minutes after the administration of preoperative antibiotics (reminder group, n = 137) or control (n = 136). After another 30 minutes, the circulating nurse was required to indicate whether a follow-up dose of antibiotics had been administered. RESULTS: Intraoperative redosing was significantly more frequent in the reminder group (93 of 137; 68%) than in the control group (55 of 136; 40%) (adjusted odds ratio, 3.31; 95% confidence interval, 1.97 to 5.56; P < .0001). The impact of the reminder was even greater when compared with the 6 months preceding the study period (129 of 480; 27%; P < .001), suggesting some spillover effect on the control group. Redosing was formally declined for 19 of the 44 patients in the reminder group without redosing. The rate of surgical-site infection in the reminder group (5 of 137; 4%) was similar to that in the control group (8 of 136; 6%; P = .42), but significantly lower than that in the pre-study period (48 of 480; 10%; P = .02). CONCLUSION: The use of an automatic reminder system in the operating room improved compliance with guidelines on perioperative antibiotic prophylaxis.

Antibiotic Prophylaxis↗
PubMed1996

[Evaluation of a protocol of health surveillance for the personnel exposed to inhalation anesthetics in a sample of 3 operating rooms].

OBJECTIVES: To verify the results of a health surveillance protocol for personnel exposed to inhalation anaesthetics. DESIGN: Yearly follow-up of operating room personnel. SETTING: Operating theatres of a university hospital; one "clean" room with waste anaesthetic scavengers, a second older room an thus "dirty", a third room with appropriate technical requirements, but with a considerable environmental emission of anaesthetics. PATIENTS OR PARTICIPANTS: Twenty-four technical surgical assistants and anaesthesiologists. INTERVENTION OR METHODS: Determination of the number of changes of air by means of concentration decay; determination of the baseline and final value of the environmental anaesthetics by infrared photoacoustic spectroscopy; analysis of the microclimate and inspection of the equipment. Determination of anaesthetics in the urine of personnel at the end of the work shift, using a gas-chromatograph with head space. Yearly medical check-up and blood tests. RESULTS: In the first year of observation we found values of nitrous oxide in one room and of isoflurane in all three rooms which exceeded the upper limit value. Acceptable values in all the rooms were detected during the second year. The values of anaesthetics found in urine samples reflected those measured in the rooms. Personnel reported subjective symptoms, but no blood alterations related to exposure were found. CONCLUSIONS: The application of the protocol has allow us to estimate the level of pollution and to suggest behavioral rules and technical precautions that have decreased the emission of anaesthetics in the environment. Blood tests are not a valid index of possible damage caused by exposure.

Air Pollutants, Occupational↗
PubMed2000

[Protection methods in the operating room and risks of blood exposure. Results of a national survey].

A national survey was conducted with 5,000 randomly chosen surgeons in order to assess the methods of protection used or warranted in the operating room against blood-borne pathogens. The rate of complete vaccination against hepatitis B was 79.2%. The use of double gloves was constant for 72% of orthopedist surgeons but only reached 28.2% for the overall surgical population. Only 46.1% of the gowns used were coated, though the quality of the barrier when it is wet is very risky. The protections taken in the operating room against blood-borne pathogens can be improved.

Adult↗
PubMed1988

Accuracy of office and operating room curettage in the grading of endometrial carcinoma.

This retrospective study reviewed the records of 375 patients with clinical stage I adenocarcinoma of the endometrium. After criteria for exclusion were applied, 223 patients were analyzed further. Results from office and operating room curettage were compared with findings at hysterectomy. Twenty percent of cases showed an increase in grade at hysterectomy after office curettage; 15% showed upgrading after operating room curettage, a nonsignificant difference. We conclude that the techniques have equivalent accuracy in the determination of tumor grade. However, despite their well-documented reliability in tumor detection, a 15-20% upgrade suggests that frozen section confirmation of grade and depth of invasion in the hysterectomy specimen may be necessary if further surgical staging is not already planned.

Adenocarcinoma↗
PubMed1999

AANA Journal course: update for nurse anesthetists--utilizing the Ohmeda draw-over vaporizer in the operating room.

The draw-over anesthesia system (DOAS) is a portable, lightweight, safe system for administering anesthesia in a remote or disaster situation. Unfortunately, the DOAS (which has many models worldwide) cannot be used in a modern operating room because it lacks safety monitors that are required by the Joint Commission on Accreditation of Healthcare Organizations and Harvard standards. Therefore, this article examines modifications to the DOAS to permit staff familiarization with it in a modern operating room. All anesthesia providers who have an interest or obligation in assisting in civil defense, humanitarian missions, or volunteer healthcare organizations should be aware of this anesthesia delivery system, its unique characteristics, and this suggested method of familiarization.

Adult↗